To ask what YOU would do to help save the NHS?

[TamiTayorismyparentingguru]

I don’t care if you’re an HCP or not, I don’t care who you vote for, I don’t care what you think about Brexit - all opinions welcome.

Opinions on practical suggestions on how to save the NHS only though.

Our local hospital is getting worse and worse with regards to staff shortages and waiting lists getting longer and longer. I will say that our GP is really great and we’ve never really had a problem with getting appointments etc, but as soon as you are referred to the hospital things go massively downhill. (We did have a GP misdiagnose/miss DH’s cancer which was pretty shit - but I wouldn’t say that was a particular problem with the system - more just one of those unfortunate things that happens, that really shouldn’t happen, but that are just a matter of course.)

The hospital is a different story though - wait lists for some departments are insane (current wait time for an initial cataracts appointment is 42 weeks and then up to 18m for treatment, paediatric dermatology is a min of 30weeks, paediatric podiatry is approx 30weeks also. I have been on a wait list for max fax for 14mths so far. I also had an 8week wait for an appointment at the breast clinic after seeing the GP with a noticeable lump.)

DH has also had to fight for every single appointment since his cancer treatment last year - instead of the 4-weekly appointments he’s meant to have had, most of his appointments have been 7-8 weeks apart and have been cancelled at the last minute (sometimes just an hour before) at least 4 times in the last year.

It’s awful and yet I do trust that the doctors, nurses, receptionists etc etc are all doing everything they possibly can.

What’s the solution?

Overhaul the procurement system. I’ve heard multiple times that different trusts are paying hugely differing amounts for products like blankets, gloves etc. There should be a central NHs ordering system so everyone pays the same price. Surely that’s got to save money?

Definitely review the prescription exemption process. I’m on thyroxine but would happily pay my prescription costs every 2 months, except the pharmacy won’t let me as it’s on the list. And then as I have the card I get all prescriptions free when I don’t need that. The list of conditions hasn’t been revised since the 60’s I think. The card should only be for the specific meds you need exemption for and possibly a few others you may need for side effects etc. Anything else is chargeable at the normal cost unless you are exempt for other reasons.

I’m sure these things have been suggested a million times and must have been looked into but I guess there is an upfront cost to change even if it saves in the long run.

Agree far too many admin staff, working inefficiently. I'm looking at you, Portsmouth Hospital. I had to meet fil in for appointment (he was going via ambulance as he is bedbound). Three women on desk, all chatting. I say to one we have an appointment. She says I need to speak to her colleague. So I turn to colleague and she shuffles files before looking up, very irritated. I repeat that we have an appointment, and she gruffly ticks off fil on list. When we leave, and I need to request ambulance collection, I ask the same lady who gets really annoyed and says that I have to ask the third person. It was absolutely ridiculous! During my wait with fil, these women spent 90% of their time chewing the fat, yet if a patient turned up, they immediately started furiously filing and looking super busy. If they actually had to do something no doubt they'd go off sick with stress.

So, I would get rid of most admin staff. I know there are masses doing sterling work and they are necessary, but everyone I know has experienced the serious over-manning (personning) of desks. Another example - a nice trip for me to the incontinence clinic. One staff member spent the whole of my two-hour wait bedecking the area with "Happy 50th Birthday" banners, balloons etc. Oh, and putting up a notice with great care asking for patients (who were already there) not to wear deodorant/perfume as a member of staff had a serious allergy and would have to go home if a patient was wearing scents (don't work with the public, then!).

I understand the sentiment behind the suggestions to charge for missed appointments but realistically the cost of admin would probably outweigh the gains.

Only in somewhere so inefficient would the admin cost outweigh the gains. It's only because the NHS would make the admin system so expensive through inefficient practices, buying/creating unnecessarily expensive software, employing even more admin staff, and probably even having to appointment a management team to oversea it! All of course multiplied hundreds of times as each NHS trust/hospital would set up their own system from scratch.

In private businesses, they'd just set up a simple system, probably off-the-shelf software, which would be operated by the existing reception staff using the existing equipment, so costs would be minimal.

Just like another thread a while ago about why GP surgeries don't accept credit cards. People were saying how it would cost each surgery tens of thousands of pounds for extra phone line, equipment rental, days of staff training at a local venue, instruction/processing manuals, and more staff would be needed to process and administer it. Typical NHS thinking - it's the way they work! A small business, such as a shop, would just get a cheap terminal (£50), connect it to the internet, and get their counter staff trained (couple of hours should do it), and off you go!

The NHS is actually one of the most efficient healthcare systems in the world. Lots of people believe what is in the Daily Mail. Lots of the Tory party are politically opposed to the NH

This. Most of the suggestions on this thread are straight out of the Daily Mail. I hope, one day, all the non clinical staff - from chief exec downwards - of these massive Trusts employing 1000's of people all walk out. Then maybe some of the clinical staff will see what exactly they do and how they can't do their jobs without them.

There should be a central NHs ordering system so everyone pays the same price. Surely that’s got to save money?

There is/was, but for some reason, it's not the cheapest and that needs to be examined as to why. Having a standarised product list and bulk buying should mean the NHS should get the cheapest possible prices - it should be impossible to buy from elsewhere cheaper!

In was well reported locally that staff on one particular ward at our local infirmary saved £50k per year by shunning the official suppliers for consumables such as rubber gloves, wipes, paper towels, etc (i.e. non clinical items) and sourcing their own via the internet and local independent suppliers. One example was paying a tenner for a box of rubber gloves that they could easily get exactly the same via ebay for a fiver! That's £50k per ward, which could be tens/hundreds of millions across the NHS, and that's only disposable items. If ward staff can do that, just what are the procurement departments doing? Or do they have the same NHS attitude of it's only low value items, so not worth worrying about when the NHS spends billions??

I think charging people for injuries when drunk is ridiculous.

I slipped on some steps and landed on my head. I had been drinking with dinner, but I wasn't hammered, it was wet and I had heels on. I was in a pretty bad way, needed an ambulance, ct scan and over night stay.

Should i have paid? It was an accident and I worked and paid my taxes, was young in good health and very rarely used the NHS.

But a fat person can have lifelong type two diabetes drugs because they don't want to change their lifestyle. Or a rugby player can have injuries fixed every weekend. Or an alcoholic can have liver disease treatment.

You can't just say some people should pay because you don't like that group. Either we all get treated or we take away free treatment completely, otherwise it's not a fair society and the rich can carry on as they like and the poor need to change their lives or suffer.

I do however agree that drunk people should not be in A&E wasting time and resources because they are drunk. They should be in a drunk tank.

Ban contract/supply staffing. All staff have to be employed by the NHS. Contract staffing is destroying budgets.

If Babylon is hoovering up all the healthy patients, the fees paid to GP surgeries have to be completely overhauled - they depend on a combination of healthy and sick patients to run their surgeries, and if all the healthy ones are using Babylon, surgeries will go out of business in a year.

Annual training targets and bursaries for all medical-related degrees, with full bursaries for all graduates required to meet them. So if we know that we need 5k new nurses, 500 radiologists and 1k GP's graduating every single year to meet needs, those places need to be fully funded. It can be adjusted according to need - it doesn't necessarily need to apply to every single young person studying physiotherapy. It needs to map onto recruitment targets and needs - especially nursing.

I do however agree that drunk people should not be in A&E wasting time and resources because they are drunk.

Something that is working well in the city nearest to where I live is a mobile triage unit. It parks up at the end of the main drinking street, where the majority of the pubs and clubs are, and stays there from 7pm to 7am. If anyone is injured while out drinking then venue staff and/or the police patrolling the area will direct them to the unit. They can treat minor injuries right there and anything needed more complicated treatment (e.g., wounds that need stitching, suspected breaks) gets a clean up, a first aid patch job and the person is then directed to A&E but is booked in remotely from the unit so that they don't need to be triaged a second time when they arrive which lowers waiting times.

It's odd that people think administrators are essential... and practice managers.

Any doctor I've seen here in Germany has had 1 receptionist (or 2, our GP) who also does light medical stuff like taking blood, doing urine tests and taking blood pressure. They answer the phone too and make appointments.
My GP types into a computer system and prints out the prescription automatically in the other room, which his receptionist/assistant then picks up. Ophthalmologist the same. Ob works without computer and will go to his assistant and tell her the prescription he wants.

In Belgium it's even more slimline (or it used to be) with no visible receptionists/assistants at all.

If you want an appointment, you call or you drop by and that's that. You have one for a time that suits you.

A letter? What's that?

@onlyhappy

I maybe wasn’t specific enough. If a drunk person suffers a life threatening or serious injury fair enough but there are a massive amount of drunk time wasters. A&E is not a drunk tank or a place for brawling, loud arrogant idiots to demand attention because they twisted their ankle, cut their hand in a fight or simply got too drunk.

In my city there are certain weekends where I would DREAD having to have an unwell child to A&E as there can be 5-6 hour wait times (even though the max should be 4) and the waiting room looks like a scene from shameless!

I also agree that severely and consistently overweight people should be charged extra and those who smoke! Both should attract a hearty surcharge as there’s very little excuse.

‘But some people have conditions that mean they’re naturally bigger and can’t help it’ 😒 no, some people have conditions which make it easier to gain/ harder to lose weight. Which is unfair yes but no more so than someone who gad type 1 diabetes ...etc.
Doesn’t mean you have the right to just shrug your shoulders and say ‘well it’s not fair so it’s not my fault and I shouldn’t have to adjust my lifestyle to balance my condition’.

Given that probably no one under 80 (okay, maybe 75) is unable to manage technology, surely letters and all associated admin will become obsolete? Virtually everything else is now managed via phone; that is what people expect.

I think in this country we are used to being nannied . In Italy the patient holds their own notes (and family's). If you have an appointment, you take them with you. They are your responsibility. Can you imagine that in the UK? "Oh, I've lost them." "I forgot them." "I don't know where they are." It would be hopeless.

I think there should be more public information campaigns. Not obscure little adverts - but Big Messages. As in, Don't Go To The Doctor With Norovirus. What the hell? Unless you have a baby/small child who is very unless, the only thing to do is hole yourself up at home and wait for it to pass. And Don't Go To The Doctor With A Sore Throat. Again, what are some people thinking?

I went to the GP a while ago (genuine reason!) and he was puffing and blowing and snorting (ugh). He said that the three previous patients had come in with colds less bad than his and wanting antibiotics.

very unless? Very unwell I meant!

It's odd that people think administrators are essential... and practice managers.

Of course "some" administrators and managers are essential. You can't get away with none at all. But you have to look at efficient working practices rather than have the default of needing ever more administrators to cover-up inefficient working practices.

I was impressed with my audiologist yesterday. Previously, they've always said to go and make a follow up appointment at reception, which turns into a lengthy job as the receptionist has to look up your notes on one system and then copy the data into another system. Yesterday, the guy just booked me in there and then as part of the normal appointment - took just a few seconds. Perhaps they're getting there after all!

In Italy the patient holds their own notes (and family's). If you have an appointment, you take them with you. They are your responsibility. Can you imagine that in the UK? "Oh, I've lost them." "I forgot them." "I don't know where they are." It would be hopeless.

The "nannying" comes because there's no consequences. People wouldn't lose or forget them if they had to pay! It's only because everything is free that people don't care and don't look after things (themselves or anything else). If you had to pay for an x-ray, you'd make sure you looked after it and took it with you when you had to.

@IAmAllAsttonishnent

But where do you draw the line. Who makes the decision between drunk time wasters whose injuries are their own fault, and those that are just victims of accidents and deserving of free treatment.

We have an issue with travel insurance companies rejecting claims for hospital treatment because the person had a glass of wine or two with dinner. Do we really want that situation with our NHS. If you've cut your hand, regardless of how or how drunk you are, you need stitching up.

You can't say no treatment for self inflicted illness/injury because most healthy people's illnesses/injuries are self inflicted in some way. It's also hard to prove if it was self inflicted. You could have had that heart attack whether your were 9 stone or 29 stone. You could turn around and say you decided that have that disabled child, you pay for them. Where do you draw the line? Who plays God in this system. What if your obese due to mental health issues or a learning disability. There are too many variables. And ultimately its the poor that suffer as the rich can afford whatever treatment they want.

I also agree that severely and consistently overweight people should be charged extra and those who smoke!

Only if those who drink excessively also pay, and drug users, and smokers, and those who've been promiscuous, and those engaging in dangerous sports, and those causing road accidents by bad driving and people just doing stupid things. It's a slippery slope. Most people needing medical treatment will have contributed to it themselves in some way. Where do you draw the line? At least with an insurance based system, your premiums would rise if you contributed towards your own problems.

I don't think starting to charge is the way forward. What we would end up with wouldn't actually be the NHS so if that's what it's going to turn into then let's all just admit that we can't save it and go down the private route properly and not by stealth. Don't get me wrong I believe in the NHS and would hate for us to move to a private system but plasters aren't going to work. We need Government to prioritise the NHS and give it a decent cash injection and lNV term security by doing this every year. I would vote for whoever genuinely takes the NHS seriously.

Do something about the high levels of surgery cancellations and inadequate services like hospital transport which end up costing money....

Case in point:

Friend was supposed to have a kidney transplant from a live donor in January. Was supposed to attend a certain clinic before this could go ahead but the hospital transport failed to turn up so transplant put back by three months. In the meantime she developed a condition relating to her renal failure which meant the transplant could no longer go ahead until she had another surgery to correct the other issue. Except a date was booked for the surgery and then cancelled on the day, then she broke her hip as a result of the secondary condition which wouldn’t have happened had the surgery gone ahead, they did further surgery to correct this and then she broke the other hip which they won’t repair surgically so she has been in hospital on permanent bed rest for seven weeks now. And meanwhile she is having to have dialysis three times a week, all of which must be costing the NHS money which it wouldn’t have cost them had the transport turned up in the first place in January....

Similarly I have a heart condition, am seen by three different hospitals for some reason. Have been battling to get surgery as I am pretty much unable to go out now. All the while been looking to be referred to a surgeon until last week when consultant admitted that actually there hasn’t been an official diagnosis yet (after two years) so surgery might never be an option....

Stop paying for treatments such as plastic surgery and definitely stop funding IVF. While the NHS can’t look after existing patients properly it certainly shouldn’t be funding treatments which creates new ones....

The excessive drinking is a huge issue and the burden on police, NHS and those cleaning up after is considerable. In my town here in the US it's a $2500 fine for an open container of alcohol in public. Public urination is a $500 fine. A bar serving someone drunk faces fines up to $10k and they have removed the license of some bars who had an issue managing their customers.

The UK should follow the lead. A £1000 fine for being drunk and disorderly would stop most of the ridiculous behavior.

But some people have conditions that mean they’re naturally bigger and can’t help it’

DS has ASD. His sensory issues mean he has no recognition of feeling full, he gets contentment and soothing from chewing, and he is oversensitive to taste so any 'nice' flavours (to him) are almost literally intoxicating and he cannot limit himself. We work very hard to keep him at a healthy weight, especially at times of high anxiety where he will binge until he's sick, if given the opportunity, as he attempts to calm himself. We won't always be here and he won't always have the young, healthy metabolism he has now with lots of exercise and physical activities so he possibly will be overweight at some point of his adult life. Why should he be charged when he genuinely cannot help it?

Charging people for illnesses or I juries deemed to be self-inflicted is a slippery slope and is far too arbitrary when in reality there are many mitigating circumstances. It's either free for all or free for none.

I think in this country we are used to being nannied . In Italy the patient holds their own notes (and family's). If you have an appointment, you take them with you. They are your responsibility. Can you imagine that in the UK? "Oh, I've lost them." "I forgot them." "I don't know where they are." It would be hopeless.

It looks like you are not used to dealing with a chronic condition:

1. If I take DD say to see a consultant endocrinologist, because it is suggested she is suffering from one condition; he produces a report confirming she does have it and what is to be prescribed. Does a copy of that letter go to her other consultants? No, it doesn't!
2. If one consultant at a tertiary centre orders a test and produces his own report, saying she has x,y,z; does a copy of it go to our local hospital, where they often treat her? No, it doesn't and neither does the copy of the report on the test results! Our local hospital then complains to us that they are left out of the loop!
3. If she suffers a fracture say and needs to see an orthopaedic consultant and I ask him to speak to her consultant in the same hospital, because of the impact each condition has on the other - do they? No, they don't!
4. DD moved GP practices a year ago. Has her new practice got her medical records from our old practice - no, they haven't? Our old practice sent them electronically last September, but the new practice does not have that system and could not receive them. Our practice sent the hard copy records to PCSE (aka Capita) in January this year - the new practice has put in repeated requests to PCSE for her medical records to no avail! We suspect Capita has lost her hard copy medical records! DH has made complaints to the CEO and Chairman of Capita, but has had no response so far!
5. Every time DD gets a new consultant, can they read her medical history on screen? No! I have to repeat it from pregnancy to date to them - I've got so fed up with it, I typed up her medical life history and just give them a copy to read!

Who actually makes sure all the consultants DD comes into contact with, have copies of other relevant reports - I do! Its like being her full time co-ordinator! The clinical specialist nurse told me the NHS is too fragmented to deal with people like DD, and she quit the NHS after 17 years in the field!

I would far prefer to go over to the systems in France or Germany. I don't know why people see the NHS as so sacred!

So in fact you are agreeing that we should be responsible for our own records.

There should be back up in a "cloud" somewhere, which could be accessed at a cost to patient if they do lose their notes.

Think how many admin staff could be eliminated with this system!

Another problem is staff retention/recruitment. What happened to nursing being an attractive career ? When and why did it change? I also would suggest a type of national service in care homes. Even when pay and conditions are excellent care homes struggle to recruit. Most people would rather be on benefits than wipe old people's bottoms. I know I would. Perhaps knocking off some student debt in return for six months in a care home would be a plan.

Re the lady who needed the transplant, could she not gave made her own way to the hospital if patient transport didn’t turn up. If she could have got to hospital all the subsequent problems would not have happened. Forgive me if she was completely immobile.

I spent time in hospital last week and was astonished at the waste of silly little things that I hadn't even thought of before like medicine dispensing cups being binned after each use, wash basins binned after each patient discharged, water cups replaced and binned 4 times a day.

Staff hadn't followed my consultants advice so had to be kept in another 24 hours... when I had already been moved ward 4 times in 36 hours due to bed shortages.